The cervical smear test has successfully reduced the number of deaths from cervical cancer but how well do you understand the basics of the screening programme, management and HPV vaccination in England?
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Samira is a 32 year old woman who is booking her cervical smear. How frequently should Samira be having a smear test?
When starting a new sexual relationship
Every two years
Every three years
Every five years
Question 1 Explanation:
Unless indicated otherwise, woman aged 25-49 should have their smear test every 3 years. Woman aged 50-64 should be tested every five years.
Which of the following are risk factors for cervical cancer? (Select 3)
First pregnancy late in life
Long term oral contraceptive use
No sexual partners
Question 2 Explanation:
Long term contraceptive use and multiple pregnancies are associated with a higher risk of cervical cancer. As cervical cancer is strongly correlated with HPV infection (99 percent of women with cervical cancer and positive for HPV) it stands to reason that immunosuppression would increase the likelihood of cervical cancer, as would multiple sexual partners. Smoking and a first pregnancy early in life also increases the risk.
Where is the cervical smear taken from?
The vaginal canal
Internal os of the cervix
Posterior fornix of the cervix
Transformational zone of external os
Which of the following HPV strains are most frequently associated with cervical cancer? (Select 2)
Question 4 Explanation:
HPV-16 and HPV-18 are most commonly associated with cervical cancer, although other strains are also reported and tested for during the cervical screen. HPV-6 and HPV-11 are associated with anal and genital warts.
What is the first stage of examining the cervical smear?
Liquid flow cytometry to identify abnormal cells
Fixation, staining and microscopy
Question 5 Explanation:
In 2019, cervical screening changed in England and Wales (and was scheduled to change in Scotland in 2020). Whereas samples used to be screened for cellular changes first, and HPV second, now all samples are screened for high-risk HPV strains first and, if positive, then screened for cellular changes. This a more sensitive test.
Samira's sample tests positive for HPV but there is no sign of dyskaryosis. What should happen next?
Repeat the test within 28 days
Arrange a colposcopy
Repeat the test in 12 months' time
Do nothing. Samira does not need another test for three years.
Question 6 Explanation:
A patient who is positive for hrHPV (high risk HPV) but with normal cytology should have a repeat smear the following year. If that gives the same result, a further repeat smear is arranged for the following year, and if that also returns the same result, the patient should be referred for colposcopy. A colposcopy should also be arranged if a patient is hrHPV-positive and has abnormal cytology. There is no need to prescribe antivirals - most woman are able to clear an HPV infection naturally.
The following year Samira has a repeat test. The results are hrHPV positive with abnormal cytology, classified as CIN2. What grade of dyskaryosis is this?
High grade (moderate)
High grade (severe)
Invasive squamous cell carcinoma
Question 7 Explanation:
Cervical intraepithelial neoplasia (CIN) refers to the thickness of the cervical layer affected by changes. CIN1 = one third affected = low grade dyskaryosis. CIN2 = two third affected = high grade (moderate). CIN3 = whole thickness affected = high grade (severe).
Samira is referred for further histological examinations via colposcopy which confirms the diagnosis and she undergoes loop diathermy (large loop excision of the transition zone). What substance does the surgeon use to better view the affected tissue?
Question 8 Explanation:
Following loop diathermy the patient should avoid sex for 3-4 weeks. They may experience period-like pains for the following 24 hours, and bleeding similar to a light period for around 1 week, but possibly up to six weeks. Their sex life should not be affected in the long term.
Samira has a young boy. At what age are children in England vaccinated against HPV?
Question 9 Explanation:
Both boys and girls in year 8 (aged 12-13) can receive the vaccine which consists of two doses 6-24 months apart. People who do not get vaccinated at that time can request a free HPV vaccination at their GP up until their 25th birthday.
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There are 9 questions to complete.
- NICE CKS Topic on Cervical Screening – https://cks.nice.org.uk/topics/cervical-screening/, accessed 22 October 2020
- Gov.UK Cervical Screening Programme Overview – https://www.gov.uk/guidance/cervical-screening-programme-overview, accessed 22 October 2020
- Incision Academy – https://academy.incision.care/courses/large-loop-excision-transformation-zone/info, accessed 22 October 2020
- BMJ Learning – Screening for cervical cancer – https://new-learning.bmj.com/course/5004436, accessed 22 October 2020